Provider Demographics
NPI:1710988753
Name:MARTHA AND MARY HEALTH SERVICES
Entity Type:Organization
Organization Name:MARTHA AND MARY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LADENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-779-7500
Mailing Address - Street 1:19160 FRONT ST NE
Mailing Address - Street 2:PO BOX 127
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-0127
Mailing Address - Country:US
Mailing Address - Phone:360-779-7500
Mailing Address - Fax:
Practice Address - Street 1:19160 FRONT ST NE
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-0127
Practice Address - Country:US
Practice Address - Phone:360-779-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1216314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4112165Medicaid
WA1216OtherNURSING HOME LICENSE
WA4515070001Medicare NSC
WA1216OtherNURSING HOME LICENSE